Pharmacy Practice

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Browsing Pharmacy Practice by Subject "Antiemetic"

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    Outcome of antiemetic prophylaxis among pediatric cancer patients receiving moderate to highly emetogenic chemotherapy at pediatric hemato-oncology ward of Tikur Anbessa specialized hospital: A prospective, observational, longitudinal study
    (Addis Ababa University, 2023) Mathewos,Hawaryaw; Ayalew,Eskinder( Ass.Prof.)
    Background: Chemotherapy induced nausea and vomiting (CINV) remains to be an important concern in pediatric patients receiving chemotherapy. However, outcomes of antiemetic prophylaxis in pediatric cancer patients are not well studied, especially in developing countries like Ethiopia. Objective: The study objective is to determine the outcome of antiemetic prophylaxis among pediatric cancer patients admitted at Tikur Anbessa specialized hospital Addis Ababa Ethiopia. Methods: A longitudinal prospective observational study design was carried out. Patients were prospectively observed for up to 120 hours post chemotherapy. The proportion of patients who had a complete response (no vomiting, no retching, and/or no need for rescue therapy) in the acute, delayed and overall phases was evaluated using descriptive statistics. Binary logistic regression was used to identify risk variables associated with the outcome of antiemetic prophylaxis with a p-value of 0.05 and 95 % confidence interval (CI). The Kaplan–Meier method was used to assess the time to first emesis event. Cox regression was used to analyze factors associated with the first emesis event using hazard ratio. Results: A total of 201 pediatric cancer patients were studied. The majority of patients 75.1% in the acute and 63.7% in the delayed phase received combination prophylactic antiemetics regimen. In the acute, delayed, and overall phases, the complete response rates were 71.1%, 68.2%, and 51.2%, respectively. A daily range of 0-8 episodes of emesis per single patient was observed in acute phase and 0-18 episodes in delayed phase. Emesis peaked on day one of treatment, occurring among 28.4% of patients and, decreased steadily throughout follow-up. Multivariable analysis revealed that emesis during the acute phase was associated with a history of motion sickness ([OR] odds ratio, 4.31, 95% CI [1.93, 9.64]), platinum-based chemotherapy (OR 5.42, 95% CI [1.97, 14.98]) and with a history of prior CIV (OR 5.02, 95% CI [2.24, 11.23]). Emesis during the delayed phase was associated with a multiple-day chemotherapy (OR 6.44, 95 % CI [1.9, 21.98], a history of prior CIV (OR 6.27, 95% CI [1.81, 21.7]), a receipt of rescue antiemetics at the acute phase (OR 3.85, 95% CI [1.18, 12.6]), and a history of motion sickness (OR 3.2, 95% CI [1.34, 7.61]). However, the likelihood of CIV was found to be reduced when steroids were present in the v chemotherapy regimen, (OR 0.16, 95 % CI [0.04, 0.73]). The time to first emesis event was markedly late in patients who took moderate emetogenic chemotherapy compared to high emetogenic chemotherapy (log rank test, P=0.025). In the overall observation period, a faster rate of first emesis event was associated with a receipt of concomitant intrathecal chemotherapy (hazard ratio [HR] 6.11, 95% CI= [1.51, 24.8]), a history of prior CIV (HR 2.0 95% CI= [1.01, 3.94]), platinum-based chemotherapy (HR 2.22 95% CI= [1.22, 4.02]), and a history of motion sickness (HR 2.1 95% CI= [1.36, 3.12]). Conclusion: A considerable number of participants could not achieve complete response. The platinum- based regimen, a history of motion sickness, and a history of prior CIV were found to have the poorest emesis control during the acute and delayed phases. Better CIV control was observed with combination antiemetic prophylaxis regimens. A delayed onset of emesis was observed with moderate emetogenic chemotherapy compared to high emetogenic chemotherapy.